Adults who used thiazide diuretics for hypertension were more likely than were those who used nonthiazide agents to develop hyponatremia within 2 years of starting treatment, a new study of more than 180,000 people has found.

Although thiazide diuretics generally are well-tolerated in the routine treatment of uncomplicated hypertension, severe adverse effects are possible, and their frequency has not been examined, according to Niklas Worm Andersson, MD, of Statens Serum Institut, in Copenhagen, Denmark, and his colleagues.

“Thiazide diuretics are commonly used drugs for the treatment of uncomplicated hypertension, and hyponatremia is a known potential side effect to thiazide treatment, but the frequency of this adverse event is inconsistently reported across drug labels,” Dr. Andersson told this news organization.

Product labels for thiazide diuretics list hyponatremia as a potential adverse event that can occur rarely (defined as a range from less than 1 in 10,000 to less than 1 in 100 individuals), but the extent of the burden is unclear given the wide range of symptoms of the condition, the researchers write. 

In a study published in Annals of Internal Medicine, Dr. Andersson and his colleagues reviewed data from population-based registries in Denmark of adults aged 40 years or older with uncomplicated hypertension, no recent prescriptions for antihypertensives, and no previous history of hyponatremia. They emulated two target trials. One trial compared the incidence of hyponatremia in new users of bendroflumethiazide (BFZ) vs a calcium-channel blocker (CCB). The other emulation compared the incidence of hyponatremia in new users of hydrochlorothiazide (HCTZ) plus a renin-angiotensin system (RAS) inhibitor vs a RAS inhibitor without HCTZ. 

The primary outcome was hyponatremia, defined as blood sodium < 130 mmol/L, within 2 years of starting treatment. 

The 2-year incidence of hyponatremia for the two thiazide diuretics was 3.83% for BFZ and 3.51% for HCTZ-RAS inhibitor. The risk difference in the incidence of hyponatremia was 1.35% for BFZ vs CCB and 1.38% for HCTZ-RAS inhibitor vs RAS inhibitor, the researchers reported. 

The study population included 37,786 new users of BFZ who were compared with 44,963 new users of CCBs as well as 11,943 new users of HCTZ-RAS inhibitors who were compared with 85,784 new users of RAS inhibitors only. 

Overall, older age and a greater number of comorbidities increased the cumulative hyponatremia in new users of thiazide-based hypertensives. The risk differences among individuals aged 80 years or older were 4.80% in the BFZ vs CCB study and 5.52% in the HCTZ-RAS inhibitor vs RAS inhibitor study. Among participants with three or more comorbidities, the risk differences in the two studies were 5.24% and 2.91%, respectively, Dr. Andersson’s group found.

The findings were limited by several factors, mainly the potential for confounding on the basis of the assumption that filled prescriptions equaled drug use, the researchers noted. Other limitations included the focus on new users and a Danish population only, which might limit generalizability, and a lack of data on blood pressure measures.

However, the results suggest a greater risk for hyponatremia with thiazide diuretics than what the drug labels indicate, especially early in treatment, the researchers concluded.

 

Data Reinforce Need for Vigilance in the Clinic

“Our findings highlight the continued need for clinical awareness and monitoring of this adverse drug reaction; particularly during the first months of treatment, in persons who are older or who have comorbidities,” Dr. Andersson told this news organization. “Further mapping of potential subpopulations at risk in terms of specific comorbidities is important to improve the prevention of this adverse event.”

“The thiazide diuretics have been recommended as first-line therapy for hypertension, and it was important to evaluate the potential development of hyponatremia, especially in the older patients given the potentially serious health effects caused by hyponatremia,” said Noel Deep, MD, a general internist in private practice in Antigo, Wisconsin. Dr. Deep, who was not involved in the study, also serves as chief medical officer and a staff physician at Aspirus Langlade Hospital in Antigo. 

The current study findings were not surprising, Dr. Deep added. “I have seen this occur in my patients, especially in the older female patients,” he said. “The results reinforce my practice of monitoring the electrolytes and renal function in 1-2 weeks after starting a thiazide diuretic, and then at regular intervals.”

In practice, clinicians should be aware of the potential development of hyponatremia and monitor and address the electrolyte abnormalities, Dr. Deep said. “While thiazide and thiazide-like diuretics are an important component of our treatment options for patients with hypertension and other conditions, we should also ensure that we are cognizant of and address the potential side effects or electrolyte imbalances caused by the medications.” 

The study was funded by the Independent Research Fund Denmark, Helsefonden, Dagmar Marshalls Fond, Gangstedfonden, A.P. Møller and Chastine Mc-Kinney Møller Foundation, Brødrene Hartmanns Fond, and Snedkermester Sophus Jacobsen og hustru Astrid Jacobsens Fond.

The researchers had no financial conflicts to disclose. Dr. Deep had no financial conflicts to disclose.

A version of this article first appeared on Medscape.com.

Adults who used thiazide diuretics for hypertension were more likely than were those who used nonthiazide agents to develop hyponatremia within 2 years of starting treatment, a new study of more than 180,000 people has found.

Although thiazide diuretics generally are well-tolerated in the routine treatment of uncomplicated hypertension, severe adverse effects are possible, and their frequency has not been examined, according to Niklas Worm Andersson, MD, of Statens Serum Institut, in Copenhagen, Denmark, and his colleagues.

“Thiazide diuretics are commonly used drugs for the treatment of uncomplicated hypertension, and hyponatremia is a known potential side effect to thiazide treatment, but the frequency of this adverse event is inconsistently reported across drug labels,” Dr. Andersson told this news organization.

Product labels for thiazide diuretics list hyponatremia as a potential adverse event that can occur rarely (defined as a range from less than 1 in 10,000 to less than 1 in 100 individuals), but the extent of the burden is unclear given the wide range of symptoms of the condition, the researchers write. 

In a study published in Annals of Internal Medicine, Dr. Andersson and his colleagues reviewed data from population-based registries in Denmark of adults aged 40 years or older with uncomplicated hypertension, no recent prescriptions for antihypertensives, and no previous history of hyponatremia. They emulated two target trials. One trial compared the incidence of hyponatremia in new users of bendroflumethiazide (BFZ) vs a calcium-channel blocker (CCB). The other emulation compared the incidence of hyponatremia in new users of hydrochlorothiazide (HCTZ) plus a renin-angiotensin system (RAS) inhibitor vs a RAS inhibitor without HCTZ. 

The primary outcome was hyponatremia, defined as blood sodium < 130 mmol/L, within 2 years of starting treatment. 

The 2-year incidence of hyponatremia for the two thiazide diuretics was 3.83% for BFZ and 3.51% for HCTZ-RAS inhibitor. The risk difference in the incidence of hyponatremia was 1.35% for BFZ vs CCB and 1.38% for HCTZ-RAS inhibitor vs RAS inhibitor, the researchers reported. 

The study population included 37,786 new users of BFZ who were compared with 44,963 new users of CCBs as well as 11,943 new users of HCTZ-RAS inhibitors who were compared with 85,784 new users of RAS inhibitors only. 

Overall, older age and a greater number of comorbidities increased the cumulative hyponatremia in new users of thiazide-based hypertensives. The risk differences among individuals aged 80 years or older were 4.80% in the BFZ vs CCB study and 5.52% in the HCTZ-RAS inhibitor vs RAS inhibitor study. Among participants with three or more comorbidities, the risk differences in the two studies were 5.24% and 2.91%, respectively, Dr. Andersson’s group found.

The findings were limited by several factors, mainly the potential for confounding on the basis of the assumption that filled prescriptions equaled drug use, the researchers noted. Other limitations included the focus on new users and a Danish population only, which might limit generalizability, and a lack of data on blood pressure measures.

However, the results suggest a greater risk for hyponatremia with thiazide diuretics than what the drug labels indicate, especially early in treatment, the researchers concluded.

 

Data Reinforce Need for Vigilance in the Clinic

“Our findings highlight the continued need for clinical awareness and monitoring of this adverse drug reaction; particularly during the first months of treatment, in persons who are older or who have comorbidities,” Dr. Andersson told this news organization. “Further mapping of potential subpopulations at risk in terms of specific comorbidities is important to improve the prevention of this adverse event.”

“The thiazide diuretics have been recommended as first-line therapy for hypertension, and it was important to evaluate the potential development of hyponatremia, especially in the older patients given the potentially serious health effects caused by hyponatremia,” said Noel Deep, MD, a general internist in private practice in Antigo, Wisconsin. Dr. Deep, who was not involved in the study, also serves as chief medical officer and a staff physician at Aspirus Langlade Hospital in Antigo. 

The current study findings were not surprising, Dr. Deep added. “I have seen this occur in my patients, especially in the older female patients,” he said. “The results reinforce my practice of monitoring the electrolytes and renal function in 1-2 weeks after starting a thiazide diuretic, and then at regular intervals.”

In practice, clinicians should be aware of the potential development of hyponatremia and monitor and address the electrolyte abnormalities, Dr. Deep said. “While thiazide and thiazide-like diuretics are an important component of our treatment options for patients with hypertension and other conditions, we should also ensure that we are cognizant of and address the potential side effects or electrolyte imbalances caused by the medications.” 

The study was funded by the Independent Research Fund Denmark, Helsefonden, Dagmar Marshalls Fond, Gangstedfonden, A.P. Møller and Chastine Mc-Kinney Møller Foundation, Brødrene Hartmanns Fond, and Snedkermester Sophus Jacobsen og hustru Astrid Jacobsens Fond.

The researchers had no financial conflicts to disclose. Dr. Deep had no financial conflicts to disclose.

A version of this article first appeared on Medscape.com.

Adults who used thiazide diuretics for hypertension were more likely than were those who used nonthiazide agents to develop hyponatremia within 2 years of starting treatment, a new study of more than 180,000 people has found.

Although thiazide diuretics generally are well-tolerated in the routine treatment of uncomplicated hypertension, severe adverse effects are possible, and their frequency has not been examined, according to Niklas Worm Andersson, MD, of Statens Serum Institut, in Copenhagen, Denmark, and his colleagues.

“Thiazide diuretics are commonly used drugs for the treatment of uncomplicated hypertension, and hyponatremia is a known potential side effect to thiazide treatment, but the frequency of this adverse event is inconsistently reported across drug labels,” Dr. Andersson told this news organization.

Product labels for thiazide diuretics list hyponatremia as a potential adverse event that can occur rarely (defined as a range from less than 1 in 10,000 to less than 1 in 100 individuals), but the extent of the burden is unclear given the wide range of symptoms of the condition, the researchers write. 

In a study published in Annals of Internal Medicine, Dr. Andersson and his colleagues reviewed data from population-based registries in Denmark of adults aged 40 years or older with uncomplicated hypertension, no recent prescriptions for antihypertensives, and no previous history of hyponatremia. They emulated two target trials. One trial compared the incidence of hyponatremia in new users of bendroflumethiazide (BFZ) vs a calcium-channel blocker (CCB). The other emulation compared the incidence of hyponatremia in new users of hydrochlorothiazide (HCTZ) plus a renin-angiotensin system (RAS) inhibitor vs a RAS inhibitor without HCTZ. 

The primary outcome was hyponatremia, defined as blood sodium < 130 mmol/L, within 2 years of starting treatment. 

The 2-year incidence of hyponatremia for the two thiazide diuretics was 3.83% for BFZ and 3.51% for HCTZ-RAS inhibitor. The risk difference in the incidence of hyponatremia was 1.35% for BFZ vs CCB and 1.38% for HCTZ-RAS inhibitor vs RAS inhibitor, the researchers reported. 

The study population included 37,786 new users of BFZ who were compared with 44,963 new users of CCBs as well as 11,943 new users of HCTZ-RAS inhibitors who were compared with 85,784 new users of RAS inhibitors only. 

Overall, older age and a greater number of comorbidities increased the cumulative hyponatremia in new users of thiazide-based hypertensives. The risk differences among individuals aged 80 years or older were 4.80% in the BFZ vs CCB study and 5.52% in the HCTZ-RAS inhibitor vs RAS inhibitor study. Among participants with three or more comorbidities, the risk differences in the two studies were 5.24% and 2.91%, respectively, Dr. Andersson’s group found.

The findings were limited by several factors, mainly the potential for confounding on the basis of the assumption that filled prescriptions equaled drug use, the researchers noted. Other limitations included the focus on new users and a Danish population only, which might limit generalizability, and a lack of data on blood pressure measures.

However, the results suggest a greater risk for hyponatremia with thiazide diuretics than what the drug labels indicate, especially early in treatment, the researchers concluded.

 

Data Reinforce Need for Vigilance in the Clinic

“Our findings highlight the continued need for clinical awareness and monitoring of this adverse drug reaction; particularly during the first months of treatment, in persons who are older or who have comorbidities,” Dr. Andersson told this news organization. “Further mapping of potential subpopulations at risk in terms of specific comorbidities is important to improve the prevention of this adverse event.”

“The thiazide diuretics have been recommended as first-line therapy for hypertension, and it was important to evaluate the potential development of hyponatremia, especially in the older patients given the potentially serious health effects caused by hyponatremia,” said Noel Deep, MD, a general internist in private practice in Antigo, Wisconsin. Dr. Deep, who was not involved in the study, also serves as chief medical officer and a staff physician at Aspirus Langlade Hospital in Antigo. 

The current study findings were not surprising, Dr. Deep added. “I have seen this occur in my patients, especially in the older female patients,” he said. “The results reinforce my practice of monitoring the electrolytes and renal function in 1-2 weeks after starting a thiazide diuretic, and then at regular intervals.”

In practice, clinicians should be aware of the potential development of hyponatremia and monitor and address the electrolyte abnormalities, Dr. Deep said. “While thiazide and thiazide-like diuretics are an important component of our treatment options for patients with hypertension and other conditions, we should also ensure that we are cognizant of and address the potential side effects or electrolyte imbalances caused by the medications.” 

The study was funded by the Independent Research Fund Denmark, Helsefonden, Dagmar Marshalls Fond, Gangstedfonden, A.P. Møller and Chastine Mc-Kinney Møller Foundation, Brødrene Hartmanns Fond, and Snedkermester Sophus Jacobsen og hustru Astrid Jacobsens Fond.

The researchers had no financial conflicts to disclose. Dr. Deep had no financial conflicts to disclose.

A version of this article first appeared on Medscape.com.

Non-Hodgkin lymphomas (NHLs) are cancers that arise in a type of white blood cell called the lymphocyte. NHLs are divided into B- and T-cell subtypes, as well as aggressive and indolent forms. Management varies widely depending on the disease type. We will focus on the most common type of NHL, diffuse large B-cell lymphoma (DLBCL), for which there have been significant treatment advances in recent years. 

DLBCL is curable in about two-thirds of patients using chemoimmunotherapy. The longstanding frontline treatment for this disease has been R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). In 2023, an antibody-drug conjugate against the B-cell surface protein CD79b, polatuzumab vedotin, was approved by the US Food and Drug Administration (FDA) in combination with R-CHP (rituximab, cyclophosphamide, doxorubicin, prednisone) for newly diagnosed DLBCL based on an improvement in progression-free survival at 2 years in patients with high-risk disease features enrolled in the POLARIX study.

For patients who do not respond to the initial treatment or in whom the disease recurs, the historical standard of care treatment strategy was high-dose chemotherapy followed by autologous stem cell transplant (ASCT). Unfortunately, this approach is not feasible or not successful in a significant percentage of patients with relapsed or refractory DLBCL. 

A newer strategy for DLBCL is chimeric antigen receptor (CAR) T-cell therapy. In this treatment, T cells are collected from a patient and genetically modified to target a protein on the lymphoma cells called CD19. This type of treatment was initially approved in the third-line setting for DLBCL based on the ZUMA-1 (axi-cel), JULIET (tisa-cel), and TRANSCEND (liso-cel) clinical trials. More recently, in 2022, 2 of these agents received approval in the second-line setting in patients who relapse or are refractory to initial treatment within 1 year; axi-cel was approved based on the ZUMA-7 trial and liso-cel was approved based on the TRANSFORM trial. 

Unfortunately, not all patients are eligible for ASCT and CAR T-cell therapy due to factors including age, comorbidities, and disease characteristics. Some patients prefer alternative therapies based on the potential side effects of CAR T-cell therapy and ASCT. Toxicities associated with CAR T-cell therapy include an inflammatory response called cytokine release syndrome and neurologic events. 

For patients who are not eligible for or who relapse after ASCT or CAR T-cell therapy, several alternative treatment options are FDA approved. Novel strategies include polatuzumab vedotin with bendamustine and rituximab and tafasitamab plus lenalidomide. Tafasitamab is a monoclonal antibody against CD19 and lenalidomide is an oral anticancer agent originally approved for use in multiple myeloma. Lenalidomide is also effective and commonly used in other NHL subtypes. 

In 2023, a new category of treatment called bispecific antibodies was approved in patients with DLBCL in whom the disease recurs after 2 lines of therapy. These drugs (epcoritamab and glofitamab) are a form of immunotherapy that connects B cells with T cells to enable a person’s own immune system to better fight the lymphoma. While these drugs can have similar toxicities as CAR T-cell therapy, the severity and incidence are much lower. In contrast to CAR T-cell therapy, which requires only 1 infusion, these drugs are given regularly in either subcutaneous or intravenous form for several months. 

Two other FDA-approved treatment options for relapsed and refractory DLBCL are loncastuximab tesirine, an antibody-drug conjugate targeting CD19 with approval based on the results of the LOTIS-2 trial, and the oral selective inhibitor of nuclear export called selinexor, based on the results from the SADAL trial. Selinexor is a fully synthetic small-molecule compound, developed by means of a structure-based drug design process known as induced-fit docking. It binds to a cysteine residue in the nuclear export signal groove of exportin 1. Selinexor is approved for use in adults with relapsed or refractory DLBCL who have received at least 2 types of systemic therapy. Trials investigating these agents in combination with other novel treatments are ongoing. 

The treatment landscape for DLBCL has changed markedly over the past several years. Therapies can be tailored for individual patients based on their disease status and characteristics, comorbidities, and treatment preferences. Research with novel strategies continues with the goal of a cure for all patients diagnosed with DLBCL.  

Non-Hodgkin lymphomas (NHLs) are cancers that arise in a type of white blood cell called the lymphocyte. NHLs are divided into B- and T-cell subtypes, as well as aggressive and indolent forms. Management varies widely depending on the disease type. We will focus on the most common type of NHL, diffuse large B-cell lymphoma (DLBCL), for which there have been significant treatment advances in recent years. 

DLBCL is curable in about two-thirds of patients using chemoimmunotherapy. The longstanding frontline treatment for this disease has been R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). In 2023, an antibody-drug conjugate against the B-cell surface protein CD79b, polatuzumab vedotin, was approved by the US Food and Drug Administration (FDA) in combination with R-CHP (rituximab, cyclophosphamide, doxorubicin, prednisone) for newly diagnosed DLBCL based on an improvement in progression-free survival at 2 years in patients with high-risk disease features enrolled in the POLARIX study.

For patients who do not respond to the initial treatment or in whom the disease recurs, the historical standard of care treatment strategy was high-dose chemotherapy followed by autologous stem cell transplant (ASCT). Unfortunately, this approach is not feasible or not successful in a significant percentage of patients with relapsed or refractory DLBCL. 

A newer strategy for DLBCL is chimeric antigen receptor (CAR) T-cell therapy. In this treatment, T cells are collected from a patient and genetically modified to target a protein on the lymphoma cells called CD19. This type of treatment was initially approved in the third-line setting for DLBCL based on the ZUMA-1 (axi-cel), JULIET (tisa-cel), and TRANSCEND (liso-cel) clinical trials. More recently, in 2022, 2 of these agents received approval in the second-line setting in patients who relapse or are refractory to initial treatment within 1 year; axi-cel was approved based on the ZUMA-7 trial and liso-cel was approved based on the TRANSFORM trial. 

Unfortunately, not all patients are eligible for ASCT and CAR T-cell therapy due to factors including age, comorbidities, and disease characteristics. Some patients prefer alternative therapies based on the potential side effects of CAR T-cell therapy and ASCT. Toxicities associated with CAR T-cell therapy include an inflammatory response called cytokine release syndrome and neurologic events. 

For patients who are not eligible for or who relapse after ASCT or CAR T-cell therapy, several alternative treatment options are FDA approved. Novel strategies include polatuzumab vedotin with bendamustine and rituximab and tafasitamab plus lenalidomide. Tafasitamab is a monoclonal antibody against CD19 and lenalidomide is an oral anticancer agent originally approved for use in multiple myeloma. Lenalidomide is also effective and commonly used in other NHL subtypes. 

In 2023, a new category of treatment called bispecific antibodies was approved in patients with DLBCL in whom the disease recurs after 2 lines of therapy. These drugs (epcoritamab and glofitamab) are a form of immunotherapy that connects B cells with T cells to enable a person’s own immune system to better fight the lymphoma. While these drugs can have similar toxicities as CAR T-cell therapy, the severity and incidence are much lower. In contrast to CAR T-cell therapy, which requires only 1 infusion, these drugs are given regularly in either subcutaneous or intravenous form for several months. 

Two other FDA-approved treatment options for relapsed and refractory DLBCL are loncastuximab tesirine, an antibody-drug conjugate targeting CD19 with approval based on the results of the LOTIS-2 trial, and the oral selective inhibitor of nuclear export called selinexor, based on the results from the SADAL trial. Selinexor is a fully synthetic small-molecule compound, developed by means of a structure-based drug design process known as induced-fit docking. It binds to a cysteine residue in the nuclear export signal groove of exportin 1. Selinexor is approved for use in adults with relapsed or refractory DLBCL who have received at least 2 types of systemic therapy. Trials investigating these agents in combination with other novel treatments are ongoing. 

The treatment landscape for DLBCL has changed markedly over the past several years. Therapies can be tailored for individual patients based on their disease status and characteristics, comorbidities, and treatment preferences. Research with novel strategies continues with the goal of a cure for all patients diagnosed with DLBCL.  

Non-Hodgkin lymphomas (NHLs) are cancers that arise in a type of white blood cell called the lymphocyte. NHLs are divided into B- and T-cell subtypes, as well as aggressive and indolent forms. Management varies widely depending on the disease type. We will focus on the most common type of NHL, diffuse large B-cell lymphoma (DLBCL), for which there have been significant treatment advances in recent years. 

DLBCL is curable in about two-thirds of patients using chemoimmunotherapy. The longstanding frontline treatment for this disease has been R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). In 2023, an antibody-drug conjugate against the B-cell surface protein CD79b, polatuzumab vedotin, was approved by the US Food and Drug Administration (FDA) in combination with R-CHP (rituximab, cyclophosphamide, doxorubicin, prednisone) for newly diagnosed DLBCL based on an improvement in progression-free survival at 2 years in patients with high-risk disease features enrolled in the POLARIX study.

For patients who do not respond to the initial treatment or in whom the disease recurs, the historical standard of care treatment strategy was high-dose chemotherapy followed by autologous stem cell transplant (ASCT). Unfortunately, this approach is not feasible or not successful in a significant percentage of patients with relapsed or refractory DLBCL. 

A newer strategy for DLBCL is chimeric antigen receptor (CAR) T-cell therapy. In this treatment, T cells are collected from a patient and genetically modified to target a protein on the lymphoma cells called CD19. This type of treatment was initially approved in the third-line setting for DLBCL based on the ZUMA-1 (axi-cel), JULIET (tisa-cel), and TRANSCEND (liso-cel) clinical trials. More recently, in 2022, 2 of these agents received approval in the second-line setting in patients who relapse or are refractory to initial treatment within 1 year; axi-cel was approved based on the ZUMA-7 trial and liso-cel was approved based on the TRANSFORM trial. 

Unfortunately, not all patients are eligible for ASCT and CAR T-cell therapy due to factors including age, comorbidities, and disease characteristics. Some patients prefer alternative therapies based on the potential side effects of CAR T-cell therapy and ASCT. Toxicities associated with CAR T-cell therapy include an inflammatory response called cytokine release syndrome and neurologic events. 

For patients who are not eligible for or who relapse after ASCT or CAR T-cell therapy, several alternative treatment options are FDA approved. Novel strategies include polatuzumab vedotin with bendamustine and rituximab and tafasitamab plus lenalidomide. Tafasitamab is a monoclonal antibody against CD19 and lenalidomide is an oral anticancer agent originally approved for use in multiple myeloma. Lenalidomide is also effective and commonly used in other NHL subtypes. 

In 2023, a new category of treatment called bispecific antibodies was approved in patients with DLBCL in whom the disease recurs after 2 lines of therapy. These drugs (epcoritamab and glofitamab) are a form of immunotherapy that connects B cells with T cells to enable a person’s own immune system to better fight the lymphoma. While these drugs can have similar toxicities as CAR T-cell therapy, the severity and incidence are much lower. In contrast to CAR T-cell therapy, which requires only 1 infusion, these drugs are given regularly in either subcutaneous or intravenous form for several months. 

Two other FDA-approved treatment options for relapsed and refractory DLBCL are loncastuximab tesirine, an antibody-drug conjugate targeting CD19 with approval based on the results of the LOTIS-2 trial, and the oral selective inhibitor of nuclear export called selinexor, based on the results from the SADAL trial. Selinexor is a fully synthetic small-molecule compound, developed by means of a structure-based drug design process known as induced-fit docking. It binds to a cysteine residue in the nuclear export signal groove of exportin 1. Selinexor is approved for use in adults with relapsed or refractory DLBCL who have received at least 2 types of systemic therapy. Trials investigating these agents in combination with other novel treatments are ongoing. 

The treatment landscape for DLBCL has changed markedly over the past several years. Therapies can be tailored for individual patients based on their disease status and characteristics, comorbidities, and treatment preferences. Research with novel strategies continues with the goal of a cure for all patients diagnosed with DLBCL.  

Key clinical point: People from a tertiary care center database were at a significantly increased risk of getting eosinophilic esophagitis (EoE) when they lived close (<1 mile) to a commercial swine farm or in an area with a high density of swine farm operations.

Major finding: Odds of EoE were ~2.5 times higher in participants who had undergone upper endoscopy and lived in an area with <1 mile proximity to a permitted swine facility (adjusted odds ratio [aOR] 2.56; 95% CI 1.33-4.95) or where the density of swine farms was >10 farms per census tract (aOR 2.76; 95% CI 1.30-5.84).

Study details: This case-control study including 401 patients with EoE and 1852 control individuals who had undergone endoscopy but did not show any esophageal pathology from a tertiary care center and 904 patients with EoE and 4074 endoscopy-based control participants from a pathology database.

Disclosures: This study was partly funded by a grant from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Cotton CC et al. Proximity to swine farming operations as a risk factor for eosinophilic esophagitis. JPGN Rep. 2023;4(4):e391 (Nov 8). doi: 10.1097/PG9.0000000000000391

Key clinical point: People from a tertiary care center database were at a significantly increased risk of getting eosinophilic esophagitis (EoE) when they lived close (<1 mile) to a commercial swine farm or in an area with a high density of swine farm operations.

Major finding: Odds of EoE were ~2.5 times higher in participants who had undergone upper endoscopy and lived in an area with <1 mile proximity to a permitted swine facility (adjusted odds ratio [aOR] 2.56; 95% CI 1.33-4.95) or where the density of swine farms was >10 farms per census tract (aOR 2.76; 95% CI 1.30-5.84).

Study details: This case-control study including 401 patients with EoE and 1852 control individuals who had undergone endoscopy but did not show any esophageal pathology from a tertiary care center and 904 patients with EoE and 4074 endoscopy-based control participants from a pathology database.

Disclosures: This study was partly funded by a grant from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Cotton CC et al. Proximity to swine farming operations as a risk factor for eosinophilic esophagitis. JPGN Rep. 2023;4(4):e391 (Nov 8). doi: 10.1097/PG9.0000000000000391

Key clinical point: People from a tertiary care center database were at a significantly increased risk of getting eosinophilic esophagitis (EoE) when they lived close (<1 mile) to a commercial swine farm or in an area with a high density of swine farm operations.

Major finding: Odds of EoE were ~2.5 times higher in participants who had undergone upper endoscopy and lived in an area with <1 mile proximity to a permitted swine facility (adjusted odds ratio [aOR] 2.56; 95% CI 1.33-4.95) or where the density of swine farms was >10 farms per census tract (aOR 2.76; 95% CI 1.30-5.84).

Study details: This case-control study including 401 patients with EoE and 1852 control individuals who had undergone endoscopy but did not show any esophageal pathology from a tertiary care center and 904 patients with EoE and 4074 endoscopy-based control participants from a pathology database.

Disclosures: This study was partly funded by a grant from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Cotton CC et al. Proximity to swine farming operations as a risk factor for eosinophilic esophagitis. JPGN Rep. 2023;4(4):e391 (Nov 8). doi: 10.1097/PG9.0000000000000391

Key clinical point: The eosinophilic esophagitis (EoE) histology scoring system (HSS) can predict the response to proton pump inhibitor (PPI) therapy in pediatric patients with EoE.

Major finding: The final EoEHSS grade score for the middle segment of the esophagus was significantly lower in patients who responded (peak eosinophil count < 15/high-power field on esophageal biopsy) vs did not respond to PPI therapy (0.3 vs 0.5; P = .037). Responders vs nonresponders had significantly lower grade values for the individual EoEHSS parameters eosinophilic abscesses (P = .044) and eosinophil surface layering (P = .046) for the middle esophagus.

Study details: Findings are from a cross-sectional study including 89 pediatric patients with EoE (age 0-18 years) who received PPI daily and were either responsive (n = 17) or nonresponsive (n = 72) at 3 months of therapy.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Jevtić J et al. The usefulness of the eosinophilic esophagitis histology scoring system in predicting response to proton pump inhibitor monotherapy in children with eosinophilic esophagitis. Diagnostics (Basel). 2023; 13(22):3445 (Nov 15). doi: 10.3390/diagnostics13223445

Key clinical point: The eosinophilic esophagitis (EoE) histology scoring system (HSS) can predict the response to proton pump inhibitor (PPI) therapy in pediatric patients with EoE.

Major finding: The final EoEHSS grade score for the middle segment of the esophagus was significantly lower in patients who responded (peak eosinophil count < 15/high-power field on esophageal biopsy) vs did not respond to PPI therapy (0.3 vs 0.5; P = .037). Responders vs nonresponders had significantly lower grade values for the individual EoEHSS parameters eosinophilic abscesses (P = .044) and eosinophil surface layering (P = .046) for the middle esophagus.

Study details: Findings are from a cross-sectional study including 89 pediatric patients with EoE (age 0-18 years) who received PPI daily and were either responsive (n = 17) or nonresponsive (n = 72) at 3 months of therapy.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Jevtić J et al. The usefulness of the eosinophilic esophagitis histology scoring system in predicting response to proton pump inhibitor monotherapy in children with eosinophilic esophagitis. Diagnostics (Basel). 2023; 13(22):3445 (Nov 15). doi: 10.3390/diagnostics13223445

Key clinical point: The eosinophilic esophagitis (EoE) histology scoring system (HSS) can predict the response to proton pump inhibitor (PPI) therapy in pediatric patients with EoE.

Major finding: The final EoEHSS grade score for the middle segment of the esophagus was significantly lower in patients who responded (peak eosinophil count < 15/high-power field on esophageal biopsy) vs did not respond to PPI therapy (0.3 vs 0.5; P = .037). Responders vs nonresponders had significantly lower grade values for the individual EoEHSS parameters eosinophilic abscesses (P = .044) and eosinophil surface layering (P = .046) for the middle esophagus.

Study details: Findings are from a cross-sectional study including 89 pediatric patients with EoE (age 0-18 years) who received PPI daily and were either responsive (n = 17) or nonresponsive (n = 72) at 3 months of therapy.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Jevtić J et al. The usefulness of the eosinophilic esophagitis histology scoring system in predicting response to proton pump inhibitor monotherapy in children with eosinophilic esophagitis. Diagnostics (Basel). 2023; 13(22):3445 (Nov 15). doi: 10.3390/diagnostics13223445

Key clinical point: Elderly patients with eosinophilic esophagitis (EoE) symptoms had <50% the odds of undergoing esophageal biopsies and longer time to diagnosis after the onset of symptoms compared with non-elderly patients.

Major finding: Elderly vs non-elderly patients were 56% less likely to undergo esophageal biopsies (adjusted odds ratio [aOR] 0.44; 95% CI 0.21-0.92) and had significantly longer time to diagnosis following symptom onset (aOR per year of symptoms preceding diagnosis 1.08; 95% CI 1.04-1.11).

Study details: The data come from a retrospective cohort study including elderly (age ≥ 65 years; n = 91) or non-elderly (age < 65 years; n = 102) patients with newly diagnosed EoE who presented with symptoms including dysphagia, chest pain, and heartburn.

Disclosures: This study was supported by a grant presented by the University of North Carolina Medical Student Summer Research Program. ES Dellon declared serving as a consultant for and receiving research funding and educational grants from various sources. The other authors declared no conflicts of interest.

Source: Kiran A et al. Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis. Aliment Pharmacol Ther. 2023 (Oct 25). doi: 10.1111/apt.17781

Key clinical point: Elderly patients with eosinophilic esophagitis (EoE) symptoms had <50% the odds of undergoing esophageal biopsies and longer time to diagnosis after the onset of symptoms compared with non-elderly patients.

Major finding: Elderly vs non-elderly patients were 56% less likely to undergo esophageal biopsies (adjusted odds ratio [aOR] 0.44; 95% CI 0.21-0.92) and had significantly longer time to diagnosis following symptom onset (aOR per year of symptoms preceding diagnosis 1.08; 95% CI 1.04-1.11).

Study details: The data come from a retrospective cohort study including elderly (age ≥ 65 years; n = 91) or non-elderly (age < 65 years; n = 102) patients with newly diagnosed EoE who presented with symptoms including dysphagia, chest pain, and heartburn.

Disclosures: This study was supported by a grant presented by the University of North Carolina Medical Student Summer Research Program. ES Dellon declared serving as a consultant for and receiving research funding and educational grants from various sources. The other authors declared no conflicts of interest.

Source: Kiran A et al. Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis. Aliment Pharmacol Ther. 2023 (Oct 25). doi: 10.1111/apt.17781

Key clinical point: Elderly patients with eosinophilic esophagitis (EoE) symptoms had <50% the odds of undergoing esophageal biopsies and longer time to diagnosis after the onset of symptoms compared with non-elderly patients.

Major finding: Elderly vs non-elderly patients were 56% less likely to undergo esophageal biopsies (adjusted odds ratio [aOR] 0.44; 95% CI 0.21-0.92) and had significantly longer time to diagnosis following symptom onset (aOR per year of symptoms preceding diagnosis 1.08; 95% CI 1.04-1.11).

Study details: The data come from a retrospective cohort study including elderly (age ≥ 65 years; n = 91) or non-elderly (age < 65 years; n = 102) patients with newly diagnosed EoE who presented with symptoms including dysphagia, chest pain, and heartburn.

Disclosures: This study was supported by a grant presented by the University of North Carolina Medical Student Summer Research Program. ES Dellon declared serving as a consultant for and receiving research funding and educational grants from various sources. The other authors declared no conflicts of interest.

Source: Kiran A et al. Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis. Aliment Pharmacol Ther. 2023 (Oct 25). doi: 10.1111/apt.17781

Key clinical point: The phenotypes of eosinophilic esophagitis (EoE) have evolved over the past two decades, with an increase in both age at diagnosis and age at onset of symptoms.

Major finding: The interval 2017-2021 vs 2002-2006 was associated with a significant increase in age at diagnosis (31.8 vs 22.0 years), frequency of dysphagia (92% vs 67%), proportion of patients with mixed presentation of inflammatory and fibrostenotic findings (68% vs 26%), and proportion of patients (age groups ≥18 years and ≥12 years) having later EoE symptom onset (all P < .001). The increase in the mixed phenotype rate persisted for the intervals after multivariate adjustment (adjusted odds ratio 1.51/interval; 95% CI 1.31-1.73).

Study details: This retrospective cohort study included 1187 adults or children (age < 18 years) with newly diagnosed EoE.

Disclosures: This study was supported by grants from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Kiran A et al. Increasing age at the time of diagnosis and evolving phenotypes of eosinophilic esophagitis over 20 years. Dig Dis Sci. 2023 (Nov 15). doi: 10.1007/s10620-023-08165-z

Key clinical point: The phenotypes of eosinophilic esophagitis (EoE) have evolved over the past two decades, with an increase in both age at diagnosis and age at onset of symptoms.

Major finding: The interval 2017-2021 vs 2002-2006 was associated with a significant increase in age at diagnosis (31.8 vs 22.0 years), frequency of dysphagia (92% vs 67%), proportion of patients with mixed presentation of inflammatory and fibrostenotic findings (68% vs 26%), and proportion of patients (age groups ≥18 years and ≥12 years) having later EoE symptom onset (all P < .001). The increase in the mixed phenotype rate persisted for the intervals after multivariate adjustment (adjusted odds ratio 1.51/interval; 95% CI 1.31-1.73).

Study details: This retrospective cohort study included 1187 adults or children (age < 18 years) with newly diagnosed EoE.

Disclosures: This study was supported by grants from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Kiran A et al. Increasing age at the time of diagnosis and evolving phenotypes of eosinophilic esophagitis over 20 years. Dig Dis Sci. 2023 (Nov 15). doi: 10.1007/s10620-023-08165-z

Key clinical point: The phenotypes of eosinophilic esophagitis (EoE) have evolved over the past two decades, with an increase in both age at diagnosis and age at onset of symptoms.

Major finding: The interval 2017-2021 vs 2002-2006 was associated with a significant increase in age at diagnosis (31.8 vs 22.0 years), frequency of dysphagia (92% vs 67%), proportion of patients with mixed presentation of inflammatory and fibrostenotic findings (68% vs 26%), and proportion of patients (age groups ≥18 years and ≥12 years) having later EoE symptom onset (all P < .001). The increase in the mixed phenotype rate persisted for the intervals after multivariate adjustment (adjusted odds ratio 1.51/interval; 95% CI 1.31-1.73).

Study details: This retrospective cohort study included 1187 adults or children (age < 18 years) with newly diagnosed EoE.

Disclosures: This study was supported by grants from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Kiran A et al. Increasing age at the time of diagnosis and evolving phenotypes of eosinophilic esophagitis over 20 years. Dig Dis Sci. 2023 (Nov 15). doi: 10.1007/s10620-023-08165-z

Key clinical point: Whole-blood IL5RA expression could serve as a noninvasive biomarker for the diagnosis of eosinophilic esophagitis (EoE).

Major finding: The expression of IL5RA was 2.36-fold higher in patients with EoE vs control individuals (P = .001). The value of area under the concentration-time curve for differentiating between the two groups was 0.85. IL5RA expression levels correlated significantly with the baseline tissue esophageal eosinophil counts on biopsy specimens (Pearson R = 0.62; P < .0001) and were associated with the total baseline endoscopy reference score (Pearson R = 0.52; P < .001).

Study details: This prospective study analyzed the whole blood samples of 20 patients with EoE who were treated with topical corticosteroids for 8 weeks before undergoing endoscopy and 20 control individuals without EoE.

Disclosures: This study was supported by grants from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Sninsky JA et al. Peripheral blood IL5RA gene expression as a diagnostic biomarker for eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2023 (Nov 7). doi: 10.1016/j.cgh.2023.10.028

Key clinical point: Whole-blood IL5RA expression could serve as a noninvasive biomarker for the diagnosis of eosinophilic esophagitis (EoE).

Major finding: The expression of IL5RA was 2.36-fold higher in patients with EoE vs control individuals (P = .001). The value of area under the concentration-time curve for differentiating between the two groups was 0.85. IL5RA expression levels correlated significantly with the baseline tissue esophageal eosinophil counts on biopsy specimens (Pearson R = 0.62; P < .0001) and were associated with the total baseline endoscopy reference score (Pearson R = 0.52; P < .001).

Study details: This prospective study analyzed the whole blood samples of 20 patients with EoE who were treated with topical corticosteroids for 8 weeks before undergoing endoscopy and 20 control individuals without EoE.

Disclosures: This study was supported by grants from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Sninsky JA et al. Peripheral blood IL5RA gene expression as a diagnostic biomarker for eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2023 (Nov 7). doi: 10.1016/j.cgh.2023.10.028

Key clinical point: Whole-blood IL5RA expression could serve as a noninvasive biomarker for the diagnosis of eosinophilic esophagitis (EoE).

Major finding: The expression of IL5RA was 2.36-fold higher in patients with EoE vs control individuals (P = .001). The value of area under the concentration-time curve for differentiating between the two groups was 0.85. IL5RA expression levels correlated significantly with the baseline tissue esophageal eosinophil counts on biopsy specimens (Pearson R = 0.62; P < .0001) and were associated with the total baseline endoscopy reference score (Pearson R = 0.52; P < .001).

Study details: This prospective study analyzed the whole blood samples of 20 patients with EoE who were treated with topical corticosteroids for 8 weeks before undergoing endoscopy and 20 control individuals without EoE.

Disclosures: This study was supported by grants from the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Sninsky JA et al. Peripheral blood IL5RA gene expression as a diagnostic biomarker for eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2023 (Nov 7). doi: 10.1016/j.cgh.2023.10.028

Key clinical point: A family history of eczema and a diet lacking allergenic foods, such as milk, increased the risk for incident eosinophilic esophagitis (EoE) in children with aerodigestive dysfunction who underwent triple endoscopy.

Major finding: A family history of eczema increased the odds of a future diagnosis EoE by ~4 times (odds ratio [OR] 4.02; P = .006) whereas a diet containing dairy significantly lowered the risk for incident EoE (OR 0.26, P = .02).

Study details: Findings are from a study including 119 patients with aerodigestive dysfunction who were age 0-21 years and underwent triple endoscopy (flexible bronchoscopy, rigid direct laryngoscopy + bronchoscopy, and esophagoscopy with biopsy), of whom 19 had EoE.

Disclosures: This study was supported by the US National Institutes of Health/National Center for Advancing Translational Science. AM Loizides declared serving as the Medical Director of Clinical Development at Albireo Pharma.

Source: Moran S et al. Factors associated with eosinophilic esophagitis in an urban, tertiary care pediatric aerodigestive population undergoing triple endoscopy. Am J Otolaryngol. 2023;45(1):104096 (Nov 5). doi: 10.1016/j.amjoto.2023.104096

Key clinical point: A family history of eczema and a diet lacking allergenic foods, such as milk, increased the risk for incident eosinophilic esophagitis (EoE) in children with aerodigestive dysfunction who underwent triple endoscopy.

Major finding: A family history of eczema increased the odds of a future diagnosis EoE by ~4 times (odds ratio [OR] 4.02; P = .006) whereas a diet containing dairy significantly lowered the risk for incident EoE (OR 0.26, P = .02).

Study details: Findings are from a study including 119 patients with aerodigestive dysfunction who were age 0-21 years and underwent triple endoscopy (flexible bronchoscopy, rigid direct laryngoscopy + bronchoscopy, and esophagoscopy with biopsy), of whom 19 had EoE.

Disclosures: This study was supported by the US National Institutes of Health/National Center for Advancing Translational Science. AM Loizides declared serving as the Medical Director of Clinical Development at Albireo Pharma.

Source: Moran S et al. Factors associated with eosinophilic esophagitis in an urban, tertiary care pediatric aerodigestive population undergoing triple endoscopy. Am J Otolaryngol. 2023;45(1):104096 (Nov 5). doi: 10.1016/j.amjoto.2023.104096

Key clinical point: A family history of eczema and a diet lacking allergenic foods, such as milk, increased the risk for incident eosinophilic esophagitis (EoE) in children with aerodigestive dysfunction who underwent triple endoscopy.

Major finding: A family history of eczema increased the odds of a future diagnosis EoE by ~4 times (odds ratio [OR] 4.02; P = .006) whereas a diet containing dairy significantly lowered the risk for incident EoE (OR 0.26, P = .02).

Study details: Findings are from a study including 119 patients with aerodigestive dysfunction who were age 0-21 years and underwent triple endoscopy (flexible bronchoscopy, rigid direct laryngoscopy + bronchoscopy, and esophagoscopy with biopsy), of whom 19 had EoE.

Disclosures: This study was supported by the US National Institutes of Health/National Center for Advancing Translational Science. AM Loizides declared serving as the Medical Director of Clinical Development at Albireo Pharma.

Source: Moran S et al. Factors associated with eosinophilic esophagitis in an urban, tertiary care pediatric aerodigestive population undergoing triple endoscopy. Am J Otolaryngol. 2023;45(1):104096 (Nov 5). doi: 10.1016/j.amjoto.2023.104096

Key clinical point: The risk for inflammatory bowel diseases (IBD), particularly Crohn’s disease, was 3.5 times higher in patients with eosinophilic esophagitis (EoE).

Major finding: Compared with control individuals without EoE, patients with EoE were at a ~3.5-fold increased risk for IBD (adjusted hazard ratio [aHR] 3.56; 95% CI 1.79-7.11), particularly Crohn’s disease (aHR 3.39; 95% CI 1.2-9.60). When compared with siblings of patients with EoE, 12 patients with EoE were diagnosed with IBD later in life compared with 11 siblings, which corresponded to an aHR of 2.48 (95% CI 0.92-6.70).

Study details: Findings are from a nationwide cohort study including 1587 patients with histologically verified EoE and 7808 age- and sex-matched control individuals without EoE.

Disclosures: This study was funded by the Consortium of Eosinophilic Gastrointestinal Disease Researcher Training Program and Karolinska Institutet, Sweden. Some authors declared serving as consultants, advisors, or speakers for or receiving financial support, grants, or fees for lectures from Karolinska Institutet and other sources.

Source: Uchida AM et al. Eosinophilic esophagitis is associated with increased risk of later inflammatory bowel disease in a nationwide Swedish population cohort. United European Gastroenterol J. 2023 (Dec 7). doi: 10.1002/ueg2.12493

Key clinical point: The risk for inflammatory bowel diseases (IBD), particularly Crohn’s disease, was 3.5 times higher in patients with eosinophilic esophagitis (EoE).

Major finding: Compared with control individuals without EoE, patients with EoE were at a ~3.5-fold increased risk for IBD (adjusted hazard ratio [aHR] 3.56; 95% CI 1.79-7.11), particularly Crohn’s disease (aHR 3.39; 95% CI 1.2-9.60). When compared with siblings of patients with EoE, 12 patients with EoE were diagnosed with IBD later in life compared with 11 siblings, which corresponded to an aHR of 2.48 (95% CI 0.92-6.70).

Study details: Findings are from a nationwide cohort study including 1587 patients with histologically verified EoE and 7808 age- and sex-matched control individuals without EoE.

Disclosures: This study was funded by the Consortium of Eosinophilic Gastrointestinal Disease Researcher Training Program and Karolinska Institutet, Sweden. Some authors declared serving as consultants, advisors, or speakers for or receiving financial support, grants, or fees for lectures from Karolinska Institutet and other sources.

Source: Uchida AM et al. Eosinophilic esophagitis is associated with increased risk of later inflammatory bowel disease in a nationwide Swedish population cohort. United European Gastroenterol J. 2023 (Dec 7). doi: 10.1002/ueg2.12493

Key clinical point: The risk for inflammatory bowel diseases (IBD), particularly Crohn’s disease, was 3.5 times higher in patients with eosinophilic esophagitis (EoE).

Major finding: Compared with control individuals without EoE, patients with EoE were at a ~3.5-fold increased risk for IBD (adjusted hazard ratio [aHR] 3.56; 95% CI 1.79-7.11), particularly Crohn’s disease (aHR 3.39; 95% CI 1.2-9.60). When compared with siblings of patients with EoE, 12 patients with EoE were diagnosed with IBD later in life compared with 11 siblings, which corresponded to an aHR of 2.48 (95% CI 0.92-6.70).

Study details: Findings are from a nationwide cohort study including 1587 patients with histologically verified EoE and 7808 age- and sex-matched control individuals without EoE.

Disclosures: This study was funded by the Consortium of Eosinophilic Gastrointestinal Disease Researcher Training Program and Karolinska Institutet, Sweden. Some authors declared serving as consultants, advisors, or speakers for or receiving financial support, grants, or fees for lectures from Karolinska Institutet and other sources.

Source: Uchida AM et al. Eosinophilic esophagitis is associated with increased risk of later inflammatory bowel disease in a nationwide Swedish population cohort. United European Gastroenterol J. 2023 (Dec 7). doi: 10.1002/ueg2.12493

Key clinical point: Budesonide oral suspension (BOS) significantly improved most of the efficacy outcomes in adolescents with eosinophilic esophagitis (EoE) over 12 weeks.

Major finding: At week 12, a significantly higher number of adolescents receiving BOS vs placebo achieved histologic (≤6, ≤1, and <15 eosinophils/high-power field; all P < .001) and clinicopathologic (P = .003) responses. BOS vs placebo led to greater reductions in the EoE histology scoring system grade (P < .001) and total EoE endoscopic reference scores (P = .021). Treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of pooled data from a phase 2 and a phase 3 study included 76 adolescents with EoE (age 11-17 years) who were randomly assigned to receive 2 mg BOS twice daily or placebo.

Disclosures: These studies were funded by Shire ViroPharma, Inc., a Takeda company, and Meritage Pharma, Inc. (now part of Shire). Some authors declared serving as consultants for or receiving research funding, etc., from Meritage, Shire, and others. Four authors declared being employees and stockholders of Takeda.

Source: Mukkada VA et al. Pooled phase 2 and 3 efficacy and safety data on budesonide oral suspension in adolescents with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2023;77(6):760-768 (Sep 18). doi: 10.1097/MPG.0000000000003948

Key clinical point: Budesonide oral suspension (BOS) significantly improved most of the efficacy outcomes in adolescents with eosinophilic esophagitis (EoE) over 12 weeks.

Major finding: At week 12, a significantly higher number of adolescents receiving BOS vs placebo achieved histologic (≤6, ≤1, and <15 eosinophils/high-power field; all P < .001) and clinicopathologic (P = .003) responses. BOS vs placebo led to greater reductions in the EoE histology scoring system grade (P < .001) and total EoE endoscopic reference scores (P = .021). Treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of pooled data from a phase 2 and a phase 3 study included 76 adolescents with EoE (age 11-17 years) who were randomly assigned to receive 2 mg BOS twice daily or placebo.

Disclosures: These studies were funded by Shire ViroPharma, Inc., a Takeda company, and Meritage Pharma, Inc. (now part of Shire). Some authors declared serving as consultants for or receiving research funding, etc., from Meritage, Shire, and others. Four authors declared being employees and stockholders of Takeda.

Source: Mukkada VA et al. Pooled phase 2 and 3 efficacy and safety data on budesonide oral suspension in adolescents with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2023;77(6):760-768 (Sep 18). doi: 10.1097/MPG.0000000000003948

Key clinical point: Budesonide oral suspension (BOS) significantly improved most of the efficacy outcomes in adolescents with eosinophilic esophagitis (EoE) over 12 weeks.

Major finding: At week 12, a significantly higher number of adolescents receiving BOS vs placebo achieved histologic (≤6, ≤1, and <15 eosinophils/high-power field; all P < .001) and clinicopathologic (P = .003) responses. BOS vs placebo led to greater reductions in the EoE histology scoring system grade (P < .001) and total EoE endoscopic reference scores (P = .021). Treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of pooled data from a phase 2 and a phase 3 study included 76 adolescents with EoE (age 11-17 years) who were randomly assigned to receive 2 mg BOS twice daily or placebo.

Disclosures: These studies were funded by Shire ViroPharma, Inc., a Takeda company, and Meritage Pharma, Inc. (now part of Shire). Some authors declared serving as consultants for or receiving research funding, etc., from Meritage, Shire, and others. Four authors declared being employees and stockholders of Takeda.

Source: Mukkada VA et al. Pooled phase 2 and 3 efficacy and safety data on budesonide oral suspension in adolescents with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2023;77(6):760-768 (Sep 18). doi: 10.1097/MPG.0000000000003948